There is a scary new twist in the national
meningitis outbreak among patients who received a tainted steroid drug. As fungal
meningitis deaths and cases rise across the US, the FDA has announced that two
additional drugs could also be culprits in the outbreak.
About 14,000 people are thought to have
been exposed to the contaminated steroid. So far, 15 have died and 214 have
been stricken, mostly with fungal meningitis, the CDC reports, though some
patients developed other fungal infections. The steroid was tainted with a fungus that
causes a type of meningitis that can result in stroke.
Now, the FDA is investigating three
additional cases of suspected fungal meningitis or other fungal infections in
patients who received other injected drugs made by New England Compounding
Center (NECC), ABC News reports. “The sterility of any
injectable drugs ... produced by NECC are of significant concern,” the FDA
Here’s a closer look at this
Fungal meningitis is a rare disease
that’s usually sparked when a fungus travels though the bloodstream to the
spinal cord. Like other forms of meningitis, which can also be caused by a
viral or bacterial infection, the disease causes swelling and inflammation of
the meninges, membranes that cover the brain and spinal cord. Unlike bacterial and viral meningitis, fungal
meningitis is not contagious.
What causes fungal meningitis?
The most common culprit is a fungus
called Cryptococcus, with
infections thought to result from inhaling soil particles contaminated with
bird droppings. This form of fungal meningitis is among the leading causes of
adult meningitis in Africa, according to the CDC.
Most cases in the current outbreak
were caused by Exserohilum, which
Tennessee state health commissioner Dr. John Dreyzehner calls “a fungus so rare that most physicians
never see it in a lifetime of practicing medicine,” according to the New York Times.
What are the symptoms?
Warning signs include headache,
stiff neck, lower-than-normal temperature, nausea or vomiting, sensitivity to
light, and hallucinations, reports
Meningitis Foundation of America, which advises anyone with these symptoms
to seek immediate medical attention.
Unlike viral or bacterial
meningitis, which tend to cause symptoms within hours of infection, the fungal
form has an incubation period that can be as long as 43 days or more. That’s
scary, since patients exposed to the tainted drugs before they were recalled
could get sick in the next few weeks or even months.
Who’s at risk?
While anyone can catch fungal
meningitis, it’s more likely to strike those with weak immune systems. Ironically,
steroid drugs suppress the immune system—and are a known risk factor for the
disease—so the combination of steroid medication and fungal contamination may
have created a perfect storm of hazards in some patients.
Why didn’t everybody who got the
tainted injections get sick?
That’s one of the more puzzling
questions of the outbreak. Experts point out that some lots of the tainted
medication may have been more contaminated than others.
FDA officials state that at least
one vial of the drug had so much “foreign matter” floating in the liquid that
the contaminants were visible to the naked eye, the New York Times reports.
In addition, some patients received
multiple shots of the drug, while others only got one injection, so were
exposed to less fungus. Yet another factor could be the injection technique,
since some doctors administering the contaminated drug may have accidentally
punctured protective membranes covering the spine, boosting risk for infection
in those patients.
How serious is the disease?
Even with prompt treatment, fungal
meningitis is a very dangerous disease that can lead to brain damage, hearing
loss, learning disabilities, speech impairment, seizures, paralysis, or death.
Several of the patients in the current outbreak have suffered strokes and so
far, 15 have died.
What’s the treatment?
Fungal meningitis is typically
treated with long courses of high-dose antifungal medications. IV therapy with
amphotericin B is the most common treatment, according to the Meningitis
Foundation of American. An oral medication called fluconalzone
can also be helpful at high doses.
What’s the best way to prevent fungal
Currently, there is no vaccine for
this disease. The CDC suggests that people with weak immune systems (such as
those with HIV/AIDS) avoid activities that expose them to soil (such as
gardening) or bird droppings.